Jammer's Review

Star Trek: Voyager

"Critical Care"

Air date: 11/1/2000
Teleplay by James Kahn
Story by Kenneth Biller & Robert Doherty
Directed by Terry Windell

Review by Jamahl Epsicokhan

"I'm going to expose you!"
"To whom? The people who employ me? They brought me here to make the hard choices they don't want to make."

— The Doctor and Chellick

In brief: An effective but not fully realized allegory on the bureaucracy of medical care.

In "Critical Care," Doc wakes up one morning (figuratively speaking, of course) and finds himself in the most chaotic wing of an alien hospital. He's thrust into an extreme situation which is written very consciously by the Voyager writers to be extreme. In the spirit of shows like last season's "Memorial" and "One Small Step," this outing goes down as another effective Voyager "message show" — the story emerges from a premise that is telling a story specifically to make a point.

Is the story's message in your face? Well, not to a point that makes it remotely unpalatable. But like "Memorial" and "One Small Step," the point is not going to escape you, because it's right there, front-and-center. It's just as well. "Critical Care" is an allegory that works on its story terms and also as something that wants to be a Classic Trekkian Commentary. After last week's awful "Repression," which wasn't about anything at all, "Critical Care" is a relief in that it turns out to be about something. And it's about it well. It plays like a good, substantive episode of The Original Series.

The allegory targets the bureaucratic corporate-ness of HMOs (Health Maintenance Organizations), which too frequently seem more interested in the bottom line than in serving their customers (patients) efficiently. No, HMOs aren't The Devil, and they aren't anything remotely approaching what's depicted in "Critical Care," but there are points here that echo the bureaucratic nonsense that patients (customers) must sit through in dealing with some HMOs, as when Dr. Voje (Paul Scherrer) tells Doc that his request must be made by filling out and submitting a form in triplicate.

Quick story. One of my coworkers injured her wrist on the job last December. That was nearly a year ago, yet today she still suffers from significant pain that interferes with simple daily activities. She probably should've had surgery long ago. The case is long and complicated, but I can assure you that the insurance companies and medical providers haven't been particularly helpful in resolving the case in any way that would avoid her stress. Perhaps the biggest kick in the head came when she got a letter saying she was suspected of making the whole thing up. Believe me, if I'd been put through the amount of nonsense she has endured, I'd probably be doing research into these companies and setting fire to their headquarters by now.

In "Critical Care," the writers turn up the heat and make the consequences more dire. Reducing patients to impersonal numbers isn't simply a side effect of inefficient corporate operation; it's an intentional means to reach a rather cynical end that has been deemed necessary by the societal Powers That Be. And the consequences extend far beyond the mere decomposition of one's patience and peace of mind, and instead lead straight into death.

The plot point used to drop Doc into this situation is that he has been stolen by a scheming opportunist named Gar (John Kassir) and sold to a medical facility on a troubled world. This facility — indeed the entire society — is lacking in resources when it comes to medical treatment. This particular area of the hospital is depicted as an understaffed, overwhelmed, dim, dank, chaotic ER. With the priority of the Hippocratic Oath taking over, Doc puts aside the fact he has been abducted and quickly lends his medical talents.

The hospital administrator, Chellick (Larry Drake), witnesses Doc's abilities firsthand and decides he would be better utilized in another section of the hospital known as Level Blue. Doc is moved out of the chaotic Level Red wing up to Level Blue ... which looks to be about as advanced as Voyager's sickbay.

It's here where the story unleashes its allegory-via-absurdity approach. Level Blue treats patients who, quite simply, do not require the treatment they're getting. Crucial medicine that would save lives on Level Red is wasted on Level Blue to proactively treat possible medical conditions that do not yet exist in these patients, and may never exist. "It increases life expectancy" is about the best justification Doc is supplied by Chellick and Level Blue Dr. Dysek (Gregory Itzin). Medicine is rationed by "The Allocator," the pre-programmed hospital computer, which was supplied its inflexible directives by Administrator Chellick. Doc is outraged. His outrage is irrelevant. Chellick tells him in no uncertain terms that This Is The Way It Is.

Why are patients on Level Blue afforded such better treatment than those on Level Red? Simple: It comes down to something called the "TC" — "Treatment Coefficient" — a formula essentially derived from a patient's current value to society (engineers who work on projects important to society have a higher TC than, say, expendable mine laborers). Patients with a higher TC get the priority for medical resources, even if they don't really need them.

What's amazing is how close to plausible Chellick is able to make his reasoning seem. There's a potent scene where Doc confronts Chellick's cold, numeric approach to patient treatment, to which Chellick responds that this once-dying society has improved dramatically under such measures. I liked that Larry Drake's performance wasn't one of a villain so much as a cold, inflexible pragmatist who has been given a job to do and is determined to do it ("They brought me here to make the hard choices they don't want to make") even if it means the lower tiers of society may be paying with their lives.

This doesn't for one second wash with Doc, however, who makes it his new mission to save the lives on Level Red, which he does by stealing medicine from Level Blue and taking it to Level Red. While on this mission he recruits reluctant Level Red Dr. Voje, who is a wonderful example of a decent guy trying to do his job within the confines of a system much bigger than him. Doc pushes at Voje to bend and eventually break the rules to give better treatment to the patients of Level Red (manipulating the TC of patients and later administering them stolen medicine). Voje is understandably reluctant and annoyed; when you've been brought up on an ethics system as screwed up as this one, turning around and risking your career to oppose it isn't necessarily the first thing to come to mind.

The Level Red situation is reduced via microcosm to a teenager named Tebbis, who is played fetchingly — almost to a fault — by Dublin James. He's a Sick Boy and a Nice Kid, and thus might as well have "Dead Meat" scrawled across his forehead in a story like this. I liked the doctor/patient relationship established between Tebbis and Doc, even if Tebbis ends up as the episode's thematic equivalent of the proverbial drowned kittens.

Indeed, one of the real strengths of "Critical Care" is the way it portrays Doc completely in the role of a healer. He takes pleasure in his work, where the highest reward is in making the sick get well. And when Tebbis unexpectedly dies and Doc learns that Chellick sat by and let it happen because the rules said so, there's a scene where Doc stares at Chellick with a look of disbelief that is conveyed about as well as surprised disgust can be. (Picardo, as usual, puts in stellar work.)

There are other really good moments here, like when Doc cleverly uses the backwardness of the system against itself, convincing Dysek that using more resources on Level Blue will lead to getting more resources (which Doc then steals and routes straight into Level Red). I also liked the riff on automated bureaucracy in the recorded message that greets Janeway when she tries to hail the medical facility.

What only worked kinda-sorta for me, however, was the ending. It seemed kind of ... anticlimactic. The idea of making Chellick a patient in his own hospital is appropriate enough, but what happens in the final act lacks a certain follow-through and ends up being pretty simple. And it doesn't really come to any resolution: By having Chellick cave in to Doc's demands at the last moment, we're not really solving any problems. Perhaps we're not supposed to be solving anything, but the story's mistake, I think, is that it doesn't really commit to a larger picture for the ending, one way or the other. Do things get better after Doc's intervention, or worse? Is any change effected? Should there be?

I also didn't quite understand Dysek's motives in going along with Doc's use of this "leverage" over Chellick. Early in the episode Dysek seems to buy completely into Chellick's way of doing things as a matter of necessity, but by the end he flip-flops without much in terms of motivation.

I guess it doesn't much matter, because the episode is about this isolated case involving Doc, and it keeps the focus on him. By the end, it indicates a certain growth on Doc's part, permitting him to infect a man with a disease in order to save a dozen others. It's an ironic situation, and it's good that the episode — and Doc himself — realizes this is the case. For Doc it's a conflict that shouldn't be permitted by his programming, because his ethics are clear: Do no harm. But something else — call it necessity — takes over in him by the end of "Critical Care." Interesting.

42 comments on this review

I just watched this today and thought it was an effective allegory on
*nationalized/socialized* healthcare (such as Great Britain, Canada, Cuba),
which often has to ration its limited resources when it claims to be "free"
(aka taxpayers) for everyone.

The acting was good, as were the special effects shots. I also loved the
scene with Janeway and Tuvok and the captain explaining she "already has a
man." The reactions in that shot were priceless.

Interesting: I felt the episode being an allegory on the United States
health care system as percieved here in Austria: Highest medical standard
in the world - but not available for a large group of the population.

I watched this for the first time the other day. It was clearly intended
as an allegory against the US system, but I also saw that it would work
very well against socialism, where the government decides priorities.
Really, when you don't have Star Trek replicators, all resources (including
medical resources) are finite and need to be rationed somehow.

The bit where the kid says he was assigned to work in the mines and would
never get a chance to train as a doctor adds to the socialist feel; it
sounds just like a communist government deciding where each individual can
best serve *society*.

It would have been interesting if the Doctor's decision had some negative
trade-offs...if the doctor over-allocating medical supplies lead to real
difficulties for the people (perhaps they end up without enough medication
when a plague hits the planet later on). Of course, this would have likely
required a follow-up episode, something Voyager is ill-equipped to do.

It's easy to argue using more resources *right now* when you're going off
in a starship, never to see the planet again. Those that stay behind have
to deal with long term issues that have been conveniently ignored.

My favorite part of this episode had nothing to do with the main
story...the sequence where Janeway and Tuvok go through a chain of people
to try to find the Doctor was standout, and not just because of the part
where Janeway pretends she's dating Tuvok. Instead of the "urgent search"
angle that usually comes up in these episodes, Janeway is portrayed as
completely bored and annoyed with all of the people she's having to deal
with. That's perfect, a nice changeup.

I agree with methane.
Here in the States, the overriding factor in whether you receive adequate
care (if you don't have insurance) is your ability to pay. Suppose you're
a garbageman (or "waste processor," like in the episode) who has cancer and
no insurance. In this episode, the centrally-planned,
socialist/communist/utilitarian "Allocator" would have deemed you unworthy
based upon occupation. In real life, your wealthy brother gives you money
and you, the garbageman, get the care you need.

After reading some of the comments, I was taken aback at how differently I
can interpret an episode from others. As an allegory on healthcare, the
Doctor was upholding, to me, the noblest principles when he argued for the
life of Tebbis, and against the inhumanity of giving treatment for
"arterial aging" on the one hand, when this medicine was essential to
Tebbis.

I suppose, as a citizen, if you are priviledged in money or ability, you
can always access Level Blue. To me, the ultimate inhumanity is not even to
think about those less fortunate - to be as blithley indifferent (to making
things better) as was Dr. Dysek in the beginning.

The similarity to the US healthcare debate is striking. It is telling that
during Obama`s speech to the Joint Congress, there was not universal moral
outrage that currently US insurance companies can kick people off coverage
when they are dying, because they are no longer profitable as customers. If
you are rich, you get Level Blue treatment, or can sue if you don`t, if you
lack money, you`re stuck in Level Red.

A large insurance company in a capitalist economy can be as unaccountable,
and bureaucratic, as the old Soviet Union. Socialism, to me, is about from
each according to their abilities, to each according to their needs - it
means moving toward Star Trek`s utopia. I can`t speak for all Canadians,
but putting tax dollars towards universal healthcare or education makes
more sense than having a huge military or using the technicalities of legal
agreements, as some large US companies do, to exploit the weak.

Does anyone remember a VOY episode when the ship docks for repairs at an
apparently abandoned station and the stations computer starts to do bad
things?
I am going through all VOY episodes and reached S7 so far and I have not
seen it. I would have sworn I saw that when I was younger.
Does anyone know what episode that is?
Thanks

Not content with turning every other episode of Voyager into a
soap-operette and/or Dr. Phil, there has to be a pervading theme of
political correctness interwoven thru the entire series. This time:
Universal health care.

Now, I'm all for saving people's lives. Providing medical treatment to
everybody should come ahead of spending on defense or supporting the
long-term unemployed. But this episode is a very thinly-veiled attempt at
socialist indoctrination. ("Reallocation" of Who the hell is The Doc to
be pontificating to other races how to organize their health care system?
Not only that, but he (it?) takes concrete steps to subvert that system and
that is portrayed as laudable! Whatever happened to cultural sensitivity,
inclusivity and relativism? Isn't that a hallowed pinnacle of political
correctness?

Oh, and screw the Prime Directive!

*barf*

Loved the scene of Janeway grabbing a hold of Tuvok's hand and his
reaction! :)))))))

The episode is fun to watch but it's sanctimonious and its instigation is
execrable. Two stars and a letter to the scriptwriters to keep their
schnozzles out of politics.

Just as the Vulcan nerve pinch seems unfailingly to work on every alien
species to which it is applied -- and even to a horselike creature in "STV:
The One That Sucked" -- here the Doctor is activated in a facility
populated by members of species we have no reason to think he's even ever
seen before and immediately starts treating them, even prescribing medicine
for them. Bad. One throwaway line of dialogue could have fixed this.

This episode can be viewed as a critique of free market health care,
especially HMOs, or as a critique of government run health care. The
episode never reveals which was intended by the writers and producers,
assuming they had a preference. Notice how Chellick never said who hired
him (government or business). Also, the reference to paperwork being in
triplicate could apply to an HMO (as Jammer inferred) or to a government
bureaucracy.

So when watching this episode decide what you DON'T want running this
nation's health care (HMO or government) and imagine that the Doctor is
fighting that organization. That way, everybody can enjoy this episode.

"...there has to be a pervading theme of political correctness interwoven
thru the entire series."

Are you kidding? One assumes you're a big enough fan of Star Trek to not
only bother reading amateur reviews but commenting on them, and you're
still amazed at the PC thread to the series?? This is one of the DEFINING
aspects of Trek, and has been ever since the very beginning. If you hate
this, then seriously - why on earth watch it? It can't be for the hard-core
SF factor, as Trek science is notoriously wobbly.

Fascinating that this episode should follow the huge debate in the comments
for the previous episode, where a flame war is raging about communism vs.
capitalism.

As I suggested there, I think extremes either side are where it all goes
wonky, and this episode illustrates that thought quite nicely: it works for
either system when taken to extremes.

It works for capitalism - which in itself could also be seen as a merit
system particularly in America where wealth is highly respected. If you
don't have the money, you die. If you do and are considered valuable to
your society (let's say Steve Jobs, CEO of Apple), you survive when 99.9%
of others wouldn't have had a chance.

It also works for communism which ironically (for Trek) is what I think was
being aimed at here. When taken to extremes, only those valuable to
society are treated. Less valuable, you die. Too much of a drain on
resources, you are terminated (though there seems to be safeguards in place
to try and prevent people being a drain on resources in the first place.
Gee.)

Just shows that it's not all black and white.

I think the UK system is fine - basic healthcare is provided for all and
they do what they can. It's not perfect - it can be disturbingly similar
in some cases (3 patients need a liver transplant... one runs the country,
one is a normal guy and one is an alcoholic. Guess which one gets it) but I
suppose they are doing the best they can with limited resources without
stooping quite to the evils depicted here.
If you want better healthcare (more comfortable, quicker response, better
prevention etc) there are still private plans and insurance policies just
like the US. The NHS is a baseline, some would call it a bare minimum.
Seems like a balance to me, I like those. I just hope Cameron doesn't kill
it.

As for the episode, an excellent commentary on a very tough debate, and
when delivered by Picardo you can't really lose. I agree that the ending
leaves a lot to be desired though (if the Doc thinks for one second that
guy will have changed his ways instead of just seeking further vengeance
against the innocent, he must be more naive than I thought). For that it
definitely loses a star - if finished properly it could've been 4.

My biggest issue with this episode is the lack of urgency. One of the crew
has been abducted and the crew seem to be somewhat bored, looking for him.
When you compare with how the crew was when B'Lanna and Harry were lost in
The Muse, it only highlights how little is thought of The Doctor.

Holy cow-- anyone who thinks that socialized medicine is the same thing as
having a socialist economy or the same thing as having a communist
government is a GRADE A IDIOT! Read a book, people. Open your brains up,
and let the information in. Do you also think that Facebook is trying to
turn the US into the USSR because it's "social" media?!?! Take off the tin
foil hats, people. I can't fathom how you are even smart enough to turn on
a computer and type words.

Sean wrote above : "it was an effective allegory on
*nationalized/socialized* healthcare (such as Great Britain, Canada, Cuba),
which often has to ration its limited resources when it claims to be "free"
(aka taxpayers) for everyone"

Nothing could be further from the truth! I live in Canada and our health
care system is good -- much better than the U.S. Everyone gets good
treatment when they need it. It is free, and it is universal, for everyone.
In contrast the system in the U.S. is just like that portrayed in the
episode Critical Care: the rich get treatment while the poor die. See
Michael Moore's Sicko. That represents what's really going on. I am glad
that Star Trek producers had the courage to do this episode. Social
commentary is what elevates much of ST above other television shows. It has
consistently advocated human rights and the rights of all sentient beings.
Universal health care is one of those basic rights. It's always amazing to
me how ideologues can twist and misrepresent such ideals for the sake of
advancing parochial interests of the elite -- just as Chellick does in the
episode.

Paul York said, "I live in Canada and our health care system is good --
much better than the U.S. Everyone gets good treatment when they need it.
It is free, and it is universal, for everyone. In contrast the system in
the U.S. is just like that portrayed in the episode Critical Care: the rich
get treatment while the poor die."

Hmm, if the Canadian system is so much better, why do Canadians keep coming
to the US for treatment? Oh, that's right, because by the time they receive
it in Canada, it might be too late for them.

And if you really think poor people are just allowed to die here, you
really are as clueless as you sound.

Yes, in the US there is preferential healthcare treatment based on what you
can pay BUT in this episode there is an "allocator" arbitrarily assigning
"worth" to individuals based on their, age, skills, education etc. This
may have shades of the US healthcare system and maybe the writers were even
trying to take a shot at the US healthcare system but if so, they missed
the mark. The presence of the allocator puts this in the field of
socialized medicine. NOT today's socialized medicine as practised in
Britain and Canada etc but a very extreme form of it. This whole episode
came off as some grad-student's back-handed attempt to be "deep."

And the Doctor was no more ethical than he claimed the administrators were.
His actions in Act 4 completely kicked the soap box he was standing on the
rest of the episode right out from under him.

"And the Doctor was no more ethical than he claimed the administrators
were. His actions in Act 4 completely kicked the soap box he was standing
on the rest of the episode right out from under him."

You're actually completely wrong here.
We know The Doctor, we have seen him grow up over the series but 1 thing
has remained constant - his actions have always resulted him doing the
right thing.
Yes, he may have pushed the limits of his ethical subroutines at that
point, however there was no chance that his actions were going to result in
anyones death. If the administrator had called The Doctors bluff, he would
have won.

As for the soapbox for the rest of the episode - again, his actions in the
end are because of that. He makes a very human decision in his way to make
a stand to try and incite change into a very shortsighted system.

As for you interpretation of the story, well, I think you're trying to be
too literal and dismiss it - I can think of a few reasons you might do
that.
But the simple point of the story is that the people who have worth(and in
a captitalist society, it is often deemed by those in charge are the ones
who have money are the ones of worth) have access to the best and the
brightest while the poorly skilled labourers(the poor) have nothing.
This episode was a commentary on the the US Heslth Care system and did a
reasonable job, for a show like Star Trek: Voyager.

As a nurse in the United States, this episode rang very true for me. For
those interpreting this episode's hospital as socialized medicine, should
reconsider. This is definitely an allegory to American healthcare. If your
wealthy or otherwise have clout then you dont have much to worry about (We
have great health care...if you can afford it) If you dont...dont get sick.
If your illnesses costs more than your insurer is willing to cover...they
do have legal ways of denying coverage that would disgust you.

On the other hand this was a great episode....a great laugh with Tuvok and
Janeway holding hands. Jammer thinks that this episode ended
anticlimactically with no real resolution...guess what ? Its the logical
place an allegory to the US system would end to...The Supreme Court will
rule in a few days on the legality of Obamacare, 11 years after this
episode aired...

There's an unfortunate truth to what Jelendra says there. As I said
earlier I'm British myself and we like to whine about waiting times or
whatever else but when you sit back and compare it.. the NHS is a wonderful
institution. At least they try.

I'm good friends with a guy from over there in the States whose mother is
dying, precisely because of that same issue (and yes, it disgusts me):
their insurers decided it was too expensive to save her, and terminated the
insurance.. including his, as the two were tied to the same contract.
There is now not only nothing anyone is willing to do for her, but he
himself has come close to suicide on a number of occasions, because he
cannot afford the Depression medication that he needs (the depression being
made worse, naturally, because of this kind of BS - not even in his 20s yet
and already bearing some of the worst that life and society have to offer
with both his mother and himself being abandoned). The state of affairs
with healthcare over there is nothing short of tragic, from my
perspective.

This episode may be 12 years old, but still very relevant. The more these
issues are examined, be it through debate or entertainment, the better
really.

I didn't think much of this episode when I first saw it, but on rewatching
it last night I was actually quite stunned by how prophetic it seemed. If
the US healthcare issue wasn't one of the foremost problems in the US when
it aired, it certainly is now. Great example of a classic Trek allegory.

It's interesting how much of a Rorschach test this episode is. Yes, this is
a very heavy handed critique of the medical system in the United States
where failure to propser means you don't live long. Yet many see it as
revealing the evils of the imaginary and wholly fictional terror of
socialized medicine. I suppose antisocial medicine would be better.

Simple fact is that some services don't lend themselves well to profit
driven businesses. Yet perhaps the most fascinating social phenomenon of
our age has been the ability of specific vested interests to convince vast
numbers of good and intelligent people to support with great vigor policies
that contradict both their self interest and fundamental morals.

Key to this is the illusion a zero sum game. This aspect is beyond the
capable scope of a 40 minute episode of minor network television science
fiction. Was this "cytoplasm" a genuine drain on resources or just a device
to illuminate an appalling value system in a manner as subtle as a
Louisville Slugger to the side of the viewer's head?

Fortunately, as noted above, this can be heavy stuff and was mixed with the
comic take of tracking down the cat-man con artist to lighten the weight.

I think the thing that really got on my nerves was that most of these
people looked completely human. No nose or forehead prosthetic, not even
any skin differentiation. The only people who got make-up jobs at all were
the thief (who looked like a Dr. Seuss character), the aliens that voyager
had to talk to in order to track him down, and the Administrator.

I guess they don't bother actually trying to make the extras look like
aliens if there are more than a handful that will be on-screen. As it's
been proven that they're capable of a much higher standard of production,
this is inexcusable. I know make-up takes time but at least slap a few
lines or spots on them or something! This was the epitome of lazy!

That aside, a very poignant episode and I really liked it for what it was.

1. great episode! intriguing
2. the captain looking annoyed during the search was great.
3. holding hands with tuvok was great.
4. i noticed the aliens who looked like earthlings (chief of medicine) and
thought, "really?"
5. i was fully entertained.

Star Trek seems to every so often turn out a great medical story, something
beyond the standard Trek plague clichés.

This was one of the great stories, in no small part due to the brilliant
character of the Doctor and the tense yet fascinatingly multi-layered drama
which you can't help but get really submerged in along with our favourite
hologram.

The gravity of the horror and disgust the Doctor feels is matched only by
the ferocity of his compassion and moral conviction. And the fact it
mirrors what we see in the world today only adds to the emotional ride
you're taken on.

I applaud the writers for rising to the challenge so well. They could have
easily spoiled everything by taking the simple un-provocative route or
turning it into a mashup of meaningless action and hallow plot manoeuvres.

Instead they gave their story heart. I imagine the subtext found here was
something they cared about. Even the standard search from Voyager was
played on differently and made fun for once!

I find it interesting (yet not overly surprising) that this episode spawned
a discussion whether it is about "capitalistic" or "socialistic" medical
treatment.

I think it is rather simple: It's about neither of them, but it targets a
deeper level: The prioritizing of treatment based on social status, rather
than medical need. No matter whether this happens in a free market (using
money), or in a planned economy (based on function), it is always the wron
approach.

I agree with Thomas, this episode was more complex than just a veiled
criticism of privatized medical care vs. socialized medical care. (BTW, as
a Canadian, our medical system is not rationed, but allocated dependent on
need, there is a difference; everyone receives treatment, you just might
have to be patient.)

Anyway, on one level, we saw a society clearly suffering (economic and
ecological catastrophes) - in their desperation they hired an outside alien
'consultant' and invested in a sophisticated 'allocation computer system'.

The sci-fi trope of letting a super-computer efficiently run a society is a
well trodden road in Trek lore. The computer was a benevolent evil, rather
than an overt one with a personality or larger motive. The system of
allocating medical treatment was based completely on algorithms and
databases.

We, the viewer grew attached to the sick boy and his mini-story, and to
find out he suddenly and so tragically ended up in the morgue drove home
the inhumanity of running an 'allocation' system by a cold-calculating
computer.

An unusually thought-provoking episode of Voyager. -- Parting thought, the
alien cityscapes in this episode were marvelous, complete with floating
medical facility.

"Critical Care" was the last episode of televised Trek that I actually I
was blown away by. It is not perfect by any means, but it is well told, it
is about *something* and features characters that I'm invested in. Those
are the requisites of dynamite Trek for me.

Enterprise was such a "dental office experience" of a series (with the
exception of "In a Mirror Darkly", which was just fanfic come to life.)
that I had no investment in the characters, so that even a thoughtful
episode like "Cogenitor" (that I saw in re-runs) didn't do much for me.

I'm saddened that the last time I was truly invested in first run Trek for
the right reasons was 14 years ago. That's truly depressing.

More loading of the dice here, I'm afraid (despite being a good episode).
The kid who is being refused care just happens to be a promising talent.
Come on. The vast majority of people in the US that can't afford care are
useless, lazy bums.

The kid is a promising medical talent not so that his worth is increased in
OUR eyes (the fact that he's a person should be enough to do that), but so
that he bonds with the Doctor.

They put them in a quasi mentor relationship so that in the end the Doctor
is willing to murder the one he sees responsible. That part of the episode
has nothing to do with the healthcare metaphor, it's all done to bring the
Doc to a darker place.

And I thought it really paid off. It's probably the part of the episode
that works the best.

"Tebbis ends up as the episode's thematic equivalent of the proverbial
drowned kittens." Best sentence of the review. That is all.

I thought the situations presented in this episode were to extreme to be
effective criticism of America’s healthcare (or any other system for that
matter). Much too convenient that the same medicine can cure one disease on
Level Red and extend lifespans of the healthy on Level Blue. The supposed
« moral dilemma » of the Doc deciding to poison the administrator falls
flat, because there is no way anyone could defend such an absurdly extreme
system.

My two cents on the health care "debate":
What some of you may not know is that the U.S. government spends as much on
health care per capita as Canada does. The problem with U.S. health care
has nothing to do with socialism or capitalism, it is the influence that
large corporations have over the government’s decisions. They finance
election campaigns and get very generous subsidies in return, which they
use not to help patients but to maximize their profits (by, among other
things, finding very complicated ways to avoid paying for treatments, thus
increasing the bureaucracy tenfold). To be blunt, a completely free-market
system OR a Canada-style system would both be much better than what you
have now.